Guideline Update: Bundle up for Pain, Agitation and Delirium

Part of AACN Critical Care Webinar Series

Presenter(s): Brenda T Pun, DNP,RN

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Webinar Summary

Pain, agitation and delirium (PAD) increase the burden of disease on critically ill patients, contributing to adverse outcomes. The 2013 PAD Guidelines for managing patients with these inter-related problems were updated in 2018, based on new evidence and input from a diverse, intraprofessional committee, resulting in “Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility and Sleep Disruption in Adult Patients in the ICU,” or the PADIS Guidelines. Brenda Pun, a leading implementer of the ABCDEF bundle, served on the 2018 guideline committee. In this webinar, she presents the PADIS Guidelines’ recommendations on the management of patients with pain, agitation and delirium, and their impact on clinical practice. She describes elements of the ABCDEF bundle and applies a case study to demonstrate the effectiveness of bundling interventions. In a second webinar, she will cover the guidelines’ recommendations on immobility and sleep disruption.


  • Identify three recommendations from the PADIS Guidelines for treating critically ill adults in pain.
  • Compare your unit’s current practice to the PADIS Guideline recommendations regarding the use of sedation.
  • Describe how implementing the ABCDEF bundle impacts patient outcomes.


Brenda T Pun, DNP,RN

Brenda T Pun, DNP,RN

Brenda Truman Pun, DNP, RN, is an advanced practice nurse with a special interest in critical care. She conducts and participates in patient-oriented, health services research at Vanderbilt University Medical Center in Nashville, Tennessee. Pun received a bachelor’s degree from Wheeling Jesuit University in Wheeling, West Virginia, a master’s of science degree in nursing from Vanderbilt University School of Nursing and a doctor of nursing practice degree from University of North Carolina – Chapel Hill. She serves as a program clinical manager in the Vanderbilt Coordinating Center, where she is involved in the creation and design of studies, grant writing, data collection and analysis, and communication of results. Her research has focused on improving the care and outcomes of critically ill patients with a special emphasis on delirium, sedation, long-term outcomes and teamwork.

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Successful Completion

Learners must attend/view/read the entire activity and complete the associated evaluation to be awarded the contact hours or CERP. No partial credit will be awarded.


This activity has been reviewed by the Nurse Planner. It has been determined that the material presented here shows no bias. No conflicts of interest have been identified for any individual with the ability to influence the content of this activity. Accreditation refers to recognition of continuing education only and does not imply AACN or ANCC approval or endorsement of any commercial products discussed or displayed in conjunction with this educational activity.


The American Association of Critical-Care Nurses (AACN) is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation, ANCC Provider Number 0012. AACN has been approved as a provider of continuing education in nursing by the California State Board of Nursing (CBRN), California Provider number CEP 1036. This activity is approved for 1.00 contact hours.

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